about yourself
Name* Email* NRIC / FIN No.* Address* Singapore* (postal code) Phone* Date of Birth* (ddmmyyyy) Gender* -Please select one- Male Female Marital status* -Please select one- Single Married Occupation* -Please select one- Academic/Educator Actor/Actress Clerical/Administrative College/Graduate Student Computer Technical/Engineering Construction Contractors/subcontractors Entertainers Executive/Managerial Hawkers Homemaker/Housewife Mechanics Other Technical Engineering Pilots Professional (Doctor, Lawyer) Renovation Retired Sales/Marketing Self-employed/own company Service/Customer Support Unemployed/looking for work Uniform Gp - Military/SCDF/Police Others None of the above Nationality* -Please select one- Singapore citizen Singapore permanent resident Brunei Indonesian Malaysian Others Driving Experience* Safe Driver Discount from Traffic Police* -Please select one- Yes No about your vehicle
Registration Number* Type of Coverage* -Please select one- Comprehensive Third Party Only (TPO) Third Party, Fire, Theft (TPFT) Detail ? Engine capacity (cc)* Unladen Wt* Max Laden Wt* Seating capacity* Year manufactured* Year of registration* Class* Make* -Please select one- Alfa Romeo Audi Bedford BMW Chevrolet Citroen Daewoo Daihatsu Datsun Fiat Ford Holden Honda Hyundai Isuzu KIA Lada Lancia Land Rover Lexus Mazda Mercedes Mini Mitsubishi Nissan Opel Perodua Peugoet Proton Renault Rover Saab Seat Skoda Subaru Suzuki Toyota Volkswagen Volvo Model* Vehicle Type* -Please select one- Van Refrigerated Van Lorry Lorry with accessories Pickup Vehicle with crane Others Vehicle Usage* -Please select one- Carry own goods Carry other's goods Parallel Imported?*
-Please select one- Yes No Company Registered Car ?*
-Please select one- Yes No about your insurance history
No Claim Discount at Next Renewal* -Please select one- 0% 10% 15% 20% Current/previous motor insurer* -Please select one- None Axa Insurance Ace Insurance (S) Ltd American International Group Asia Insurance Co Ltd Allianz Insurance (S) Co Ltd Assurance Pte Ltd China Insurance Co Ltd Cosmic Insurance Corporation Ltd Liberty Citystate Insurance Co Ltd CGU International Assurance Plc First Capital Insurance Ltd Guardian Royal Exchange Assurance Plc General Accident Insurance Asia Ltd HSBC Insurance (International) Ltd Insurance Corporation of Singapore Ltd India International Insurance Pte Ltd ING General Insurance International N.V. Kemper International Keppel Insurance Pte Ltd London & Pacific Insurance Co Bhd Maybank Assurance Mitsui Marine & Fire Insurance Co Ltd Nayang Insurance Co Ltd Nippon Fire & Marine Insurance Co Ltd NTUC INCOME Overseas Assurance Corporation Ltd People's Insurance Co Ltd (Hartfard) QBE Insurance (International) Ltd Royal & Sun Alliance Insurance Ltd Tat Lee Insurance Ltd Tokio Marine & Fire Insurance Co (S) Pte Ltd Tai Ping Insurance Co Ltd Union Des Assurance De Paris I.A.R.D UMBC Insurans Sdn Bhd United Overseas Insurance Ltd Winterthur Insurance (Far East) Pte Ltd Wing On Fire & Marine INsurance Co Ltd Yasuda Fire & Marine Insurance Co (Asia) Pte Ltd Zurich eagle Insurance (S) Pte Ltd Total no of claims in last 3 years* -Please select one- None 1 2 3 more than 3 Total claim amount in last 3 years* -Please select one- None $1,500 and below $1,501 to $3,000 $3,001 to $5,000 $5,001 to $10,000 $10,000 to $15,000 $15,000 to $20,000 $20,001 & above Current Finance Company about your named drivers
Named Driver 1 Date of Birth (ddmmyyyy) Driving Experience Relationship to Insured Named Driver 2 Date of Birth (ddmmyyyy) Driving Experience Relationship to Insured
about your new policy
Next Commencement Date* (ddmmyyyy) Expiry Date* (ddmmyyyy) about your renewal notice
Already received your renewal notice?* -Please select one- Yes No If yes, what was the quote received?* Premium $
Introduction
Travel Insurance
